Madison County employees fight privatization of ADAPT alcohol and drug program (Video)

WAMPSVILLE - County employees picketed outside the Madison County Office Building before filing into a public hearing Wednesday evening to voice concerns over the potential privatization of the ADAPT program.

As it has done with several of its other health care programs, Madison County is considering privatizing its ADAPT program, which provides evaluation and treatment of individuals who abuse or are dependent on chemical substances and/or have mental health concerns. The county-run out-patient clinic is a not a mandatory service.

The cost to run the program has fluctuated in recent years. In the last five years the program has run on a deficit that has ranged from as high as $89,174 to as low as $10,906.

A task force was developed, comprised of county officials, management and mental health professionals, to examine the possibility of ending the county's involvement in the program. Notices were submitted to 50 agencies, four responded and the prospective agency to take over was narrowed down to one: Family Counseling Services of Cortland County.

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Comments made at Wednesday's public hearing will be included in the task force's recommendation to the Social and Mental Health Services Committee and the Community Services Board, which govern the Mental Health Department program.

Madison County Administrative Assistant Mark Scimone said it's more and more difficult for governmental agencies to continue to be involved in direct patient care. Operating the program also exposes the county to make potential errors in medical billing, which can come with substantial penalties.

"Money is scarce here at the county and we cannot afford to be putting money into departments the way that we used to," Board of Supervisors Chairman John Becker said. "It can't be business as usual."

John Salka, chairman of the Social and Mental Health Services and Public Health Services committees, said mandates and strained budgets have created a "contentious environment" that requires services to be delivered as efficiently as possible. The decision to privatize the ADAPT program won't be taken lightly, he said. The county's foremost goal is to "make sure services are delivered in the most compassionate and efficient manner," he said.

While recognizing that the potential change will affect a lot of people, Salka said the county needs to focus on delivering the best possible care while making sure "we don't run the bank broke in the process."

Many other counties in New York are also exploring privatization of its mental health programs and several - including Herkimer, Fulton and Lewis counties - have already outsourced programs.

He assured those in attendance at the meeting that the decision to privatize hasn't been "pre-determined." He even pointed to two similar considerations made in the past - in 2000 and 2004 - when the county discussed privatizing the mental health department and instead opted not to.

With the agencies who responded with interest to their inquiries for privatization, Yonai said Family Counseling Services of Cortland County was one of the best. Operating in a county similar in size to Madison County, their agency is fully certified in out-patient clinical services and mental health services, he said.

Their executive director, Lisa Hoeschele at Wednesday's hearing said their non-profit organization was founded in 1970 and now has 11 chemical dependency counselors and 16 mental health counselors.

"What we hope to do here is replicate what we're already doing and what's already being done here," she said.

Madison County's program currently employs about 10 staff and serves up to 165 clients a month. The program may be run better in the private sector, Scimone said. He was confident that the level of care would not be compromised. For the program's employees will hopefully be picked up by the agency taking over.

If the county follows through with the privatization, the transaction must be approved by the New York State Office of Alcoholism and Substance Abuse Services. Unlike the sale of the operating license for the county's home health care and long-term home health care agencies, the county won't make any money by privatizing ADAPT. It may have to subsidize the program with funding from the county coffers but according to Scimone, that would only last, at most, two years.

County employees disagree with the prospect of privatizing and vocalized their discontent at the public hearing Wednesday while holding signs from their picket that read "keep treatment local," "vote 'no' to private care," "keep care that works" and "keep treatment public.

Russ Stewart, president the CSEA White Collar Unit, said the ADAPT team has met in recent months and has tried to come up with ways to increase the number of clients in serves. If there was a lapse in services, workers should have been made aware of it, he said.

He was "shocked" that no one from ADAPT was asked to speak at the meeting on behalf of the program but its employees instead were limited to making three-minute comments with everyone else who showed up.

"It seems like the county no longer needs to ensure services in return for our tax dollars," said Betty Jo Johnson, president of the Madison County Local 827 CSEA union and Department of Social Services employee.

She questioned why the county would replace a successful program with a private agency that will still cost it money. With a major drug epidemic in Madison County right now, Johnson said county officials are disregarding the needs of residents.

Bill Walker, an ADAPT counselor, said it doesn't make sense for the county to shut down one agency just to open another. Recognizing a gap in services, he said the agency has undertaken the workload of what three organizations used to handle and have only added one counselor in the last six years. "Drug use is on the rise" and if the ADAPT program hasn't evolved to meet that need, it's management's fault, he said.

New Woodstock resident Elizabeth Holmes asserted that county officials were basing their actions on a fear of financial responsibility.

"You're doing all this based on what," she asked. "Fear? Fear that the Office of the Medical Inspector General is going to charge penalties?"

ADAPT Counselor Shauna O'Brien said the program has improved "year after year."

"Clients aren't just another number to us," she said. "They mean a lot to us. I hate to see a program end because of stuff like this. I am helping give stability when they have none. I hate to see that ripped away from them," she tearfully pleaded.

"Don't we deserve better," 33-year county employee Jeff Colburn said.

Serving a county dotted with meth labs that has become the "mecca" of bath salt use, Colburn said county officials have formulated their decision with little input from the public or ADAPT. Given the county's drug epidemic and ADAPT's work to combat it, the county should keep the program, he said.

"They don't work for Madison County as an entity," he said of ADAPT workers. "They work for 'we the people' and 'we the people' are asking, 'don't we deserve better?'"

Denise Calcagrino, a social worker with ADAPT, questioned why management didn't pursue better methods of provide services if the program was deficient. She criticized county leadership and the program's management for not providing the proper support and guidance to correct the program and improve services.

"There's no stopping us," she said. "I know what we're capable of."

Scimone anticipates that the task force will make a recommendation on how to proceed in the next few weeks and said the full board will likely address the issue at its October meeting.